Introduktion: Olika typer av sår skapar stort lidande för den drabbade och Negative Pressure Wound Therapy (NPWT) är en behandlingsmetod som utvecklats för att effektivisera sårläkningsprocessen. Livskvaliteten och hälsan påverkas av såret och dess utveckling, vilket gör omvårdnaden vid sårbehandling grundläggande för patientens välmående. Syfte: Syftet var att belysa hur Negative Pressure Wound Therapy påverkar patientens livskvalitet och hälsa. Metod: Polit och Beck (2012) niostegsmodell användes för litteraturstudien. Artikelsökningarna gjordes i två olika databaser samt manuella sökningar och resultatet grundades på tolv artiklar som genomgick en kvalitetsgranskning. Resultat: Fem teman identifierades påverka patientens upplevelse av behandlingen. Behandlingen påverkar den fysiska förmågan att leva ett dagligt liv och tenderar att framkalla smärta vid omläggning. Behandlingen tenderar även att på ett psykiskt påfrestande sätt påverka både det allmänna välmåendet och det sociala livet. Kunskap och information, hos både personal och patient, visades ha en inverkan på patientens livskvalitet och hälsa. Slutsats: Denna avancerade sårbehandling påverkar patientens livskvalitet och hälsa. Behandlingen innebär en fysisk påfrestning där patienten behöver bära runt på en behandlingsmaskin samt uppleva smärta. Det innebär också en psykisk påfrestning som ger utryck i stress, oro och rädsla samt en risk för isolering i det sociala livet. Det är därför av största vikt att vårdpersonal införskaffar sig och tillgodoser patientens behov av information och kunskap för att förutsättningar för en optimal omvårdnad ska kunna skapas.

Because of the high cost of some wound management regimens, payors may require that moist wound therapies be used before other treatment approaches, such as negative pressure wound therapy (NPWT), are implemented but few studies have investigated the effect of delayed initiation of NPWT on patient outcomes. To examine the impact of early versus late initiation of NPWT on patient length of stay in home health care, a nonrandomized, retrospective analysis was performed on the Outcome and Assessment Information Set (OASIS) information for home care patients with NPWT-treated Stage III or Stage IV pressure ulcers (N = 98) or surgical wounds (N = 464) gathered between July 2002 and September 2004. Early initiation of NPWT following the start of home care was defined as <30 days for pressure ulcers and <7 days for surgical wound patients. Median duration of NPWT was 31 days (range 3 to 169) for pressure ulcers and 27 days (range 5 to 119) for the surgical wound group. Median lengths of stay in the early treatment groups were 85 days (range 11 to 239) for pressure ulcers and 57 days (range 7 to 119) for the surgical group versus 166 days (range 60 to 657) and 87 days (range 31 to 328), respectively, for the late treatment pressure ulcer and surgical groups (P <0.0001). After controlling demographic patient variables, regression analysis indicated that for each day NPWT initiation was delayed, almost 1 day was added to the total length of stay (β = 0.96, P <0.0001 [pressure ulcers]; β = 0.97, P <0.0001 [surgical wounds]). Early initiation of NPWT may be associated with shorter length of stay for patients receiving home care for Stage III or Stage IV pressure ulcers or surgical wounds. Additional studies to ascertain the cost-effectiveness of treatments and treatment approaches in home care patients are needed.

Introduktion/Bakgrund: Negative Pressure Wound Therapy är en sårbehandling som är vanlig vid sekundär sårläkning och kan användas på många olika typer av sår. Undertryck skapas med ett specifikt skumförband som placeras i sårhålan och kopplas till en vakuumpump. Syfte: Syftet med litteraturstudien var att beskriva patienters erfarenhet av Negative Pressure Wound Therapy (NPWT). Metod: Litteraturstudien utformades utifrån Polit och Becks (2021) nio steg. I databaserna Cinahl och PubMed genomfördes litteratursökning, samt en kompletterande manuell sökning. Totalt elva artiklar var relevanta för studiens syfte och granskades utifrån granskningsmallarna ”Guide to a Focused Critical Appraisal of Evidence Quality in an Qualitative Research Report” samt “Guide to a Focused Critical Appraisal of Evidence Quality in a Quantitative Research Report. Resultat: Artiklar som belyste patienters erfarenhet av Negative Pressure Wound Therapy resulterade i tre teman: ”Sjuksköterskans kompetens vid NPWT”, ”Påverkan på livssituationen vid NPWT”, samt ”Oro och smärta”. Slutsats: Sjuksköterskans kompetens inom sårbehandling samt Negative Pressure Wound Therapy visade sig ha en stor betydelse för patienters negativa och positiva erfarenheter av Negative Pressure Wound Therapy. Därav finns ett behov av adekvat kompetens hos sjuksköterskor för att patienters behov ska tillgodoses samt för att styrka patientsäkerheten.

Our objective was to compare cefazolin concentrations in biopsied tissue samples collected from surgically created wounds treated with negative pressure wound therapy to those collected from surgically created wounds treated with nonadherent dressings. The study design was a prospective, controlled, experimental study. The animal population included 12 female spayed beagles. We hypothesized there would be a difference between the cefazolin concentrations of wounds treated with negative pressure wound therapy when compared to the cefazolin concentrations of wounds treated with nonadherent dressings. Surgical methods were as follows: Full thickness cutaneous wounds were created on each antebrachium (n=24). Following surgery, cefazolin (22 mg/kg) was administered intravenously to each of the dogs and continued every 8 hours during the study. The right wound was randomly assigned to group I or group II while the wound on the contralateral antebrachium was assigned to the other group. Group I wounds were treated with negative pressure wound therapy (NPWT) and group II wounds were treated with nonadherent dressings for 3 days. Dressings were changed and tissue biopsies obtained from wound beds at 24-hour intervals for both groups. Cefazolin wound tissue and plasma concentrations were measured by liquid chromatography mass spectrometry (LC-MS/MS). Blood samples for measuring plasma cefazolin concentrations were collected prior to biopsy sampling. At the time of surgery and at each bandage change, wound beds were swabbed and submitted for aerobic and anaerobic culture. Our results revealed that after initiating cefazolin treatment, wound tissue antibiotic concentrations between treatment groups were not significantly different at any sampling time. Similarly, after initiating cefazolin treatment, plasma cefazolin concentrations were not significantly different at any sampling time for individual dogs. We concluded that using a canine experimental model, NPWT treatment of surgically created wounds does not statistically impact cefazolin tissue concentrations when compared to conventional nonadherent bandage therapy / Master of Science

The purpose of this study was to examine the clinical outcomes of negative pressure wound therapy (NPWT) using reticulated open-cell foam (ROCF) in the adjunctive management of abdominal wounds with exposed and known infected synthetic mesh. A non randomised, retrospective review of medical records for 21 consecutive patients with infected abdominal wounds treated with NPWT was conducted. All abdominal wounds contained exposed synthetic mesh [composite, polypropylene (PP), or knitted polyglactin 910 (PG) mesh]. Demographic and bacteriological data, wound history, pre-NPWT and comparative post-NPWT, operative procedures and complications, hospital length of stay (LOS) and wound healing outcomes were all analysed. Primary endpoints measured were (1) hospital LOS prior to initiation of NPWT, (2) total time on NPWT, (3) hospital LOS from NPWT initiation to discharge and (4) wound closure status at discharge. A total of 21 patients with abdominal wounds with exposed, infected mesh were treated with NPWT. Aetiology of the wounds was ventral hernia repair (n = 11) and acute abdominal wall defect (n = 10). Prior to NPWT initiation, the mean hospital LOS for the composite, PP and PG meshes were 76 days (range: 21-171 days), 51 days (range: 32-62 days) and 19 days (range: 12-39 days), respectively. The mean hospital LOS following initiation of NPWT for wounds with exposed composite, PP and PG mesh were 28, 31 and 32 days, respectively. Eighteen of the 21 wounds (86%) reached full closure after a mean time of 26 days of NPWT and a mean hospital LOS of 30 days postinitiation of NPWT. Three wounds, all with composite mesh left in situ, did not reach full closure, although all exhibited decreased wound dimensions, granulating beds and decreased surface area exposure of mesh. During NPWT/ROCF, one hypoalbuminemic patient with exposed PP mesh developed an enterocutaneous fistula over a prior enterotomy site. This patient subsequently underwent total mesh extraction, takedown of the fistula and PP mesh replacement followed by reinstitution of NPWT and flap closure. In addition to appropriate systemic antibiotics and nutritional optimisation, the adjunctive use of NPWT resulted in successful closure of 86% of infected abdominal wounds with exposed prosthetic mesh. Patient hospital LOS (except those with PG mesh), operative procedures and readmissions were decreased during NPWT compared with treatment prior to NPWT. Future multi-site prospective, controlled studies would provide a strong evidence base from which treatment decisions could be made in the management of these challenging and costly cases.

Gabriel A, Shores J, Bernstein B, de Leon J, Kamepalli R, Wolvos T, Baharestani MM, Gupta S. A Clinical Review of Infected Wound Treatment with Vacuum Assisted Closure ® (V.A.C. ®) Therapy: Experience and Case Series. ABSTRACT Over the last decade Vacuum Assisted Closure ® (KCI Licensing, Inc., San Antonio, TX) has been established as an effective wound care modality for managing complex acute and chronic wounds. The therapy has been widely adopted by many institutions to treat a variety of wound types. Increasingly, the therapy is being used to manage infected and critically colonized, difficult-to-treat wounds. This growing interest coupled with practitioner uncertainty in using the therapy in the presence of infection prompted the convening of an interprofessional expert advisory panel to determine appropriate use of the different modalities of negative pressure wound therapy (NPWT) as delivered by V.A.C. ® Therapy and V.A.C. Instill ® with either GranuFoam ™ or GranuFoam Silver ™ Dressings. The panel reviewed infected wound treatment methods within the context of evidence-based medicine coupled with experiential insight using V.A.C. ® Therapy Systems to manage a variety of infected wounds. The primary objectives of the panel were 1) to exchange state-of-practice evidence, 2) to review and evaluate the strength of existing data, and 3) to develop practice recommendations based on published evidence and clinical experience regarding use of the V.A.C. ® Therapy Systems in infected wounds. These recommendations are meant to identify which infected wounds will benefit from the most appropriate V.A.C. ® Therapy System modality and provide an infected wound treatment algorithm that may lead to a better understanding of optimal treatment strategies.

Prompt diagnosis and treatment of necrotizing fascitis reduces the morbidity and mortality rates of this devastating disease. To examine the clinical outcomes of using negative pressure wound therapy in the adjunctive management of wounds secondary to necrotizing fascitis, a retrospective review of medical records was conducted. Participants included 11 consecutive patients (16 wounds) with a diagnosis of necrotizing fascitis admitted to a teaching hospital between 2000 and 2005 and treated on an inpatient basis with negative pressure wound therapy. The patients included seven men, four women (average age 54 years; range 18 to 82 years). Variables abstracted from the medical records and consultation notes included: demographic information, tissue and blood bacteriological data, wound history, wound healing outcomes, duration of negative pressure wound therapy, length of hospital stay, and mortality and morbidity information. Variables were entered into an electronic database and analyzed. Operative tissue biopsies were obtained and all participants received serial surgical debridements as well as infection, nutrition, and hemodynamic support. Negative pressure wound therapy was applied to the wound(s) at 125 mm Hg continuous negative pressure until reconstructive closure could be performed. Most wounds (10) were on lower extremities, seven patients presented with sepsis, and beta-hemolytic Streptococcus was identified in nine wounds. Mean number of negative pressure wound therapy treatment days was 25 (range: 7 to 74), mean length of stay was 67 days (range: 21 to 186). All wounds were successfully closed ĝ€" 73% received split-thickness skin grafts, 27% required flaps, 100% limb salvage was achieved, and all patients survived. No negative pressure wound therapy or dressing-associated complications were observed. Negative pressure wound therapy was found to be a viable adjunctive treatment in the management of wounds associated with necrotizing fascitis.

Bakgrund: Undertrycksbehandling eller Negative Pressure Wound Therapy (NPWT) är en sårbehandling som ofta används när andra behandlingar inte lyckats med läkningen av det kroniska såret. Flera forskningsstudier stödjer metodens effektivitet gällande sårläkning och bildande av granulationsvävnad, men behandlingens påverkan på patienten och dennes upplevelse av att använda behandlingen är bristfällig.Syfte: Syftet med studien var att beskriva patientens upplevelse av att genomgå undertrycksbehandling av ett sår och om behandlingen påverkar patientens livskvalitet.Metod: Litteraturstudie baserad på kvalitativa artiklar som svarade på huvudsyftet och kvantitativa artiklar som svarade på frågeställningen.Resultat: Informanterna upplevde att NPWT-enheten var ett fokus i behandlingen. Behandlingen var smärtsam och påverkade det dagliga livet och informantens självbild. Informanterna upplevde en brist på information och stöd och en inkonsekvens i vårdpersonalens kunskap och kompetens. Ingen signifikant skillnad i livskvaliteten påvisades vid jämförelse av NPWT och standard sårbehandling.Konklusion: NPWT-behandlingen upplevdes som en krävande sårbehandling där patienten utmanades både fysiskt och psykiskt. Behandlingen innebar mycket eget ansvar, var starkt förknippad med smärta och oro och ångest överskuggade målet med behandlingen. / Background: Negative Pressure Wound Therapy (NPWT) is a wound therapy, often used, when other therapies fail to heal the chronic wound. Several research studies support the effectiveness of the method regarding wound healing and granulation tissue formation, but the effect of treatment on the patient and his experience of using the treatment is lacking. Aim: The aim of the study was to describe the patient´s experience of undergoing negative pressure wound therapy and if the treatment affects the patient´s quality of life. Method: Literature review based on qualitative articles that responded to the main objective and quantitative articles that answered the research question. Results: The informants felt that the NPWT device was a focus in the treatment. The treatment was painful and affected the daily life and the informant´s self-image. The informants experienced a lack of information and support, and an inconsistency in the nursing staffs knowledge and skills. No significant difference in the quality of life were proved by comparing NPWT and standard wound treatment.Conclusion: NPWT treatment was perceived as a demanding wound treatment where the patient was challenged both physically and mentally. Treatment entailed a lot of own responsibility, was highly associated with pain and worry and anxiety overshadowed the goal of treatment.

Bakgrund: Sårvård medför höga kostnader för samhället och bidrar till sänkt livskvalitet för den drabbade individen. Det är viktigt med en effektiv och personcentrerad sårvård för att patienten ska kunna bibehålla en god livskvalitet. Vakuumassisterad sårbehandling är en metod som har blivit allt vanligare för behandling av sår. Syfte: Syftet med studien var att beskriva patienters erfarenheter av vakuumassisterad sårbehandling. Metod: Studien genomfördes som en allmän litteraturstudie av åtta kvalitativa artiklar. Resultat: Fyra teman identifierades: att delta i en ny spännande behandlingsmetod, att vara begränsad i sin vardag, att ha smärta och att ha behov av kunskap och stöd. Konklusion: Patienterna såg fram emot att delta i en ny spännande behandlingsmetod. Patienterna upplevde att de begränsades fysiskt, psykiskt och socialt samt hade behov av stöd. Genom att beskriva patienters erfarenheter av vakuumassisterad sårbehandling identifieras områden som sjuksköterskan behöver vara medveten om för att kunna ge en personcentrerad och god evidensbaserad vård. / Background: Wound care entails high costs for society and contributes to a reduced quality of life for the affected individual. Effective and person- centered wound care is important for the patient to be able to maintain a good quality of life. Negative pressure wound therapy is a method that has become increasingly common for the treatment of wounds. Purpose: The purpose of the study was to describe patients' experiences of negative pressure wound therapy. Method: The study was conducted as a general literature study of eight qualitative articles. Results: Four themes were identified: participating in a new exciting treatment method, being limited in everyday life, having pain and needing knowledge and support. Conclusion: The patients looked forward to participating in a new exciting treatment method. The patients felt that they were limited physically, psychologically and socially and had a need for support. By describing the patients' experiences of negative pressure wound therapy, areas are identified that the nurse needs to be aware of in order to provide person- centered and good evidence-based care.

INTRODUCTION: Negative pressure wound therapy (NPWT) has proved to be a powerful tool in facilitating the healing of difficult wounds of a variety of etiologies. The pediatric experience with NPWT has been limited because of concerns about vascular compression and pain associated with treatment. METHOD: A retrospective review (2004-2014) was conducted at Shriners Hospital for Children-Boston to evaluate the therapeutic effect of NPWT on children with difficult wounds due to burns or soft-tissue trauma. Information was collected on patient demographics, wound size and depth, burn injury etiology, length of hospital stay, number of operating room visits, and other treatment procedures. NPWT was instituted in the operating room under general anesthesia using a commercially available system. NPWT was not initiated until all necrotic material had been removed from the wounds. A negative pressure varying between -50 and -125 mmHg was applied to the wound as continuous suction, with younger children being prescribed the lower negative pressures. NPWT dressings were changed every 5-7 days in the operating room. When wounds were clean and granulated, they were closed with split-thickness skin grafts. RESULTS: Twenty-nine children with an average age of 9.43 +/- 1.95 years (range 2 months to 18 years) were treated with NPWT. The average total wound size was 24.8 +/- 8.9% (range 0%-95%) of the body surface in patients who had suffered burns and non-burn injuries. Injury mechanisms were categorized as hot liquid (2 children), contact with hot object (4 children), electricity (7 children), flame (9 children), and other non-burn injuries such as abrasion and degloving (7 children). Over 90% of the patients required central venous or bladder catheters. Perceived benefits of the treatment included reduced numbers of dressing changes and more rapid wound granulation. There were no episodes of bleeding associated with NPWT. All patients healed their wounds, were successfully grafted, and survived. CONCLUSION: NPWT has a useful role in the pediatric burn unit in facilitating wound healing and improving quality of life. A significant correlation between the size of third-degree burn wounds and the number of negative pressure therapies suggests that NPWT may be more effective in treating complicated burn wounds. Overall, NPWT appears safe and effective when applied to well-debrided wounds, and the treatment does not seem to be associated with excessive bleeding or discomfort in children.